COVID-19 Update #291
HFAM Update

Our sector navigated most of June and July without a single new patient or resident COVID-19 case. That said, this is NOT the time to let our guard down on infectious disease protocols or in peer-to-peer outreach on vaccination.  We are entering a troubling and challenging time in the current surge.

Today, there are more than 30 outbreaks in skilled nursing and rehabilitation centers and about ten outbreaks in assisted living centers. This is up from less than ten outbreaks in either setting about a month ago. Fortunately, the outbreaks remain limited in the number of specific cases. These cases seem to be driven by the Delta variant, and we see a very small percentage of breakthrough cases.
In this surge going forward, I am very concerned about staffing in Maryland hospitals and our sector—there are fewer healthcare workers across all settings right now, and often a necessary reliance on agency staff.

Please see the below update from Governor Mark Parkinson and our colleagues at the American Health Care Association and National Center for Assisted Living (AHCA/NCAL)
 Some Key Points:
  • We are all concerned about the Delta variant and breakthrough cases of vaccinated individuals.
  • Across the nation at varying growth rates, we are in a surge of the COVID-19 virus – driven mainly by the Delta variant and unvaccinated individuals.
  • Recent data released by the CDC indicates that vaccinated individuals can spread the Delta variant.
  • Given the trend of the virus over the last year, we are worried about future COVID-19 variants this fall.
  • There will come a time for vaccination boosters, perhaps to coincide with the traditional flu vaccination season this fall – now is the time to prepare.
One Additional Critical Point in Three Parts:
  • Thank you for the quality care you and your teams provide to Marylanders in need. You are saving lives and helping people get stronger to be their best selves, given the clinical challenges they face.
  • Now more than ever, it is essential that you share your quality care story with resident and patient families, care partners across all healthcare settings, and with crucial relationship partners. We will soon be sending a link for an online education program we recently did on this subject – I highly recommend that folks watch the program and apply the winning strategies discussed.
  • In recent weeks and this week, we will continue to see proposed federal reforms for our sector coming out of Congress, as we did during the most recent session of the Maryland General Assembly. In next year’s session, and on the federal front, we will navigate proposed reforms, and together we will offer reforms with our sector expertise and navigate this time of change.
As Always:
  • Focus on what is in your control and not what is out of your control.
  • Overcommunicate.
  • Adapt and innovate.
  • Rely on your partnerships.
  • Speak up when you need help.
  • Double efforts on infectious disease protocols, training, and operations.
  • Take and document your action; keep a timeline.
  • CLICK HERE for the Dr. Katz Video, and please see the Donning and Doffing Checklist we have been sharing
Onward together!

Be well,
Joe DeMattos
President and CEO
A Message from the AHCA/NCAL President & CEO Mark Parkinson

I thought we’d never have a year as tough as 2020. I know that we all hope that is correct, but 2021 has proven to be incredibly challenging. This year has so far presented a new list of obstacles.

Fortunately, COVID-19 cases in our buildings have declined dramatically. And that is the most important fact. But the Delta variant has shown us that COVID-19 isn’t gone. Delta – combined with staffing shortages, low census, vaccine hesitancy, and all the other issues we face – has turned this into another historically difficult year. 

There are flickers of hope. This memo will discuss those and exactly where we stand. First, I’ll focus on the clinical picture. Second, I’ll talk about the business side of our profession. Then, we’ll get into all the action in Washington, D.C.  


The clinical nightmare is not over. The Delta variant has proven remarkably effective at finding the unvaccinated. Unfortunately, even some vaccinated people are at risk. 

But we need to keep this in perspective. Although cases in the general population are back to summer 2020 numbers, cases in our buildings continue to be way down.

We peaked at 33,000 cases a week back in December. Despite the massive increase of Delta in the general population, we continue to report less than 1,000 cases a week in skilled nursing facilities. Even with a slight increase in cases in the past few weeks, we are still down over 97 percent from the highest case reports. There is no safer place in America right now for an older person than our long term care facilities. 

Given how rapidly Delta is spreading in some states and communities around the country, we have no idea if we can continue to keep it out of buildings. Anyone who professes to know exactly how the virus is going to spread (or not spread) just hasn’t been paying attention to the last year. This virus has consistently proven to be unpredictable. We must assume that renewed spread in our buildings is a real possibility, and we must remain vigilant.

Here is what we do know:
  1. The vaccine works. Even with the spread in the community, buildings with a very high vaccination rate have fared well.
  2. We continue to be vulnerable where the outside community has high levels of COVID-19 cases.
  3. The Delta variant may burn itself out. 

Looking at the spread of the Delta variant in India, we see the dramatic increase of the Delta variant, but it also shows that it declined after a ten-week period. That happened even though only seven percent of India is vaccinated. A similar increase and drop over a ten-week period appear to be taking place in the United Kingdom. If this pattern follows in the U.S., we will see an increase in the country through August followed by the same rapid decline at some point in September. But there is really no way to know. This virus is just too unpredictable. 

In the meantime, I know you will continue the fight to keep it out of buildings. 


Many of you are struggling with the mandatory vaccination issue. It’s a tough one. We all want every worker vaccinated, but every provider in the country in also facing an absolute staffing crisis. We support whatever decision you make and genuinely understand the complexity of this issue. More and more providers are mandating the vaccine, and their experiences may provide clarity to all of us. 

In the meantime, we have put together best practices for increasing vaccination rates and offer many additional resources through our #GetVaccinated campaign. We know there are no simple answers, but there are operators who have worked hard to improve vaccination rates among their staff and been very successful. We will host a webinar on August 11 to highlight two successful operators and share key findings from a report recently commissioned by the AHRQ ECHO National Nursing Home COVID-19 Action Network, Invest in Trust: A Guide for Building COVID-19 Vaccine Trust Among Certified Nursing Assistants (CNAs) . Please be sure to register today to learn about the helpful tools and gain the knowledge of what has worked to help improve staff vaccination rates.


The business challenge continues. It’s a two-fold problem of census and staffing. The good news is that census is rising slowly but steadily. On the skilled nursing side, we bottomed out in January and have had a slight increase for 26 of the last 28 weeks. Although there isn’t data as precise as the SNF NHSN data, we believe that assisted living census follows essentially this same pattern.

We still have work to do. At the current recovery pace, it will take us ten more months to recover to pre-pandemic numbers, but we will be in significantly better shape by the end of the year. The key is that the increases need to continue. We can’t afford another leg down.
One interesting data point is that there is a connection between staff vaccination rates and census. We’ve done some work on the topic, and it is clear that facilities with high staff vaccination rates also have higher census.

We also know from our research that consumers are looking for facilities with high vaccination rates. The bottom line is that census is still low, and the sector can’t recover until census recovers.


Because the clinical and business challenges continue, we know we must keep winning in D.C. Fortunately, we’ve had a couple of pieces of good news over the last week.

First, CMS agreed to leave PDPM alone for the next year. In announcing our final payment rule for 2022, CMS did not cut our rates. In fact, on October 1, we will receive a 1.2 percent increase. This is terrific news and one of the building blocks needed for us to recover. These rates will be in effect until October of 2022, and hopefully by then, census will be back to normal, and we will be on our way to recovery.

Our success on the payment rule did not happen accidentally. We have a group of dedicated members who work year-round to prepare for the annual announcement. Without their involvement, there is no way we could have achieved this result. Debbie Meade has put together a terrific reimbursement cabinet, and we owe each of them our thanks. Our CMS Member Meeting team includes Martin Allen, Len Russ, Robin Hillier, Mary Ousley, and John Barber. 

The second piece of good news from last week is that Congress left the Provider Relief Fund (PRF) money alone. There had been talk of Congress using it to pay for the infrastructure bill. As crazy as that seems, Congress seriously considered it. In the end, that did not happen; none of the PRF was used to fund the current infrastructure proposal.

So now we can play offense, and we have two big tasks to accomplish. The first is that we need to get the U.S. Department of Health & Human Services (HHS) to pay out the remaining PRF funds. The good news is there is actually more money in the PRF than we thought 10 days ago. We thought that the general PRF fund only had $24 billion. It turns out that the general fund actually has $44 billion. Additionally, there is a separate $8 billion allocation for rural providers, meaning $52 billion are available in total. 

We have doubled down on our efforts to encourage HHS to distribute the funds. We believe this remaining $52 billion offers an important opportunity for both skilled nursing and assisted living. Getting aid out to providers is our number one priority because we know that this support is critical.

The second big task for 2021 is the infrastructure bill. There are two parts to this legislation, and we are continuing to work on both. In the first bill, although it’s subject to change before passage, there is broadband money that may be accessible to providers for upgrades and enhanced WiFi. We will continue to monitor and provide important updates as it moves forward.

There will be lots of opportunities for our profession in the second bill – but also multiple challenges. We believe assisted living may not face a significant risk, but skilled nursing faces all sorts of additional regulatory challenges. We will work hard to fight back against duplicative and unnecessary regulatory burdens.

The second infrastructure bill also offers opportunity. The AHCA Board released our bold nursing home reform plan, the Care For Our Seniors Act, at the start of 2021, and this bill is the vehicle for it. We need a new and fairer regulatory system, to fix Medicaid underfunding, and help with staffing. Our proposals address all these key topics.


For the last six-plus years, Scott Tittle has done a terrific job as NCAL Executive Director. Under his leadership, we’ve grown to 46 affiliates, increased our membership over 40 percent, and most important, prevailed on all the key challenges that assisted living has faced. Scott is now leaving NCAL to take a job in Indianapolis, where his wife and family live, so that he can spend more time with them. We will miss him but understand and respect his decision.

Starting in September, the new executive director of NCAL will be LaShuan Bethea. LaShuan brings a wealth of experience to the position. She joined Genesis HealthCare in February 2007 and quickly advanced to the director of regulatory and program development before being promoted in 2015 to vice president of legislative affairs. She assumed a dual role as vice president of reimbursement in 2020. On top of that, she is a nurse and an attorney. I am excited for LaShuan to join our team. She is going to be a great leader of NCAL.


It’s time to get everyone back together, and our annual meeting is an important place to start. The venue is the Gaylord in D.C., right on the Potomac River. The setting in October couldn’t be nicer.

The programming will be top notch. Take advantage of the more than 85 education sessions on topics such as rebuilding census, PDPM, infection control, trauma-informed care, and workforce. Attendees can earn up to 15.5 CEs. Network with your colleagues from across the country and connect with over 350 businesses in the Expo Hall. Special events include the 15th Annual NCAL Day, featuring a keynote from the Ritz-Carlton Leadership Center, and the National Quality Award Ceremony & Celebration, which will recognize both the 2020 and 2021 recipients.

This year’s general sessions include several LED Talks, featuring leaders, staff, and family from AHCA/NCAL member facilities. They will talk about what it was like to be on the frontlines throughout the pandemic. You will be uplifted and inspired by their personal stories of spirit, hope, and compassion. I’m looking forward to seeing everyone there, so be sure to register today.  


It’s discouraging that 2021 has been so tough. We know that. But we also know that giving up is not an option. Our residents, their families, our employees, and their families are all counting on us continuing the fight against this pandemic and the fight for survival. 

It’s almost cliché to say that we will get through it. So often that is a hollow line at the end of a speech. But it’s not hollow here. We will get through this. We will. Next year – 2022 – will be better, and there will be a time when we can look back on this era with pride. We refused to quit and did everything possible for our residents.

It’s a great honor to represent you in D.C., and we will work as hard as we can to justify the confidence you have placed in us.

Mark Parkinson
President and CEO
Additional Updates and Reminders
Updates from the Maryland Department of Health

Medicaid Rates: Please see this Medicaid update memo regarding July 1, 2021 rates. Per this memo, the final calculation for the rates, effective July 1, 2021, is delayed. In the interim, the Department's FY 2021 fourth quarter rates for nursing facility services will remain in effect until final rates are available. As soon as rates are available, the Department will adjust payments as appropriate.

Medicaid Redeterminations: Please see this memo announcing that MDH has extended Medicaid redeterminations to December 31, 2021. Keep in mind that families, facilities, and representatives of participants are encouraged to complete their renewals as close to the scheduled redetermination as possible. The sooner the renewal is completed, the sooner staff can update the case. This extension gives more time but does not extend past December 31, 2021.
AHCA Summary of FY 2022 SNF Final Payment Rule

The Centers for Medicare & Medicaid Services (CMS) recently issued the final rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2022 update. Highlights include:  

  • The final rule provides a net market basket increase for SNFs of 1.2 percent beginning October 1, 2021.

  • The CMS net market basket update would increase Medicare SNF payments by approximately $411 million in FY 2022.

  • CMS will not implement any PDPM payment model parity adjustment in FY 2022. Whether there will be any delay or phase in necessary will be revisited in next year’s FY 2023 proposed rule. 

AHCA has provided a summary of the final rule. If you have any questions, please contact the relevant subject matter expert listed in the summary.
Upcoming Webinar! OSHA ETS - August 9 at 1:00 PM

In partnership with CleanHealth Environmental and LeadingAge Maryland, we will be hosting a webinar on the OSHA Emergency Temporary Standard on Monday, August 9 at 1:00 PM.

On June 10, 2021, the Occupational Safety and Health Administration (OSHA) issued the COVID-19 Healthcare Emergency Temporary Standard (ETS), solely for healthcare employers, including long-term care. The intent of the ETS is to mitigate the spread of COVID-19, where workers have been at higher risk of infection. While some LTC facilities may have components of the ETS requirements, a number of portions of the regulation are new for LTC. Therefore, a thorough understanding of the regulatory requirements is essential to achieve compliance.

The deadline for compliance has already passed, as full compliance was mandated by July 21, 2021. Time is of the essence to ensure that employees are being provided a safe workplace free from hazards. Join us to learn how to best implement the OSHA ETS at your facility.

The webinar will address:

  • Overview of the OSHA Emergency Temporary Worker Protection Standard

  • Determination if the ETS Applies to Your Facility

  • Detailed Requirements to Meet Compliance

  • Enhanced Enforcement by OSHA

  • Call To Action - Steps to Compliance
The 2022 AHCA/NCAL National Quality Award Program Year Is Now Open
Application Packets Are Available!

AHCA/NCAL is excited to announce that the 2022 National Quality Award Program year is now open and application packets are available! We encourage members to begin planning this month.

Get Started

  • New to the program? Take these steps.
  • Continuing your quality journey at the Silver and Gold Award levels? Take these steps.

Why Apply Now?

This is the time to re-evaluate your organization's strengths and opportunities, identify critical areas for improvement, and implement a plan to be more resilient and successful than ever before. 

The National Quality Award Program's rigorous three-level process (Bronze, Silver, and Gold) evaluates organizations' capabilities against nationally recognized standards for excellence. The program is one of the most comprehensive and cost-effective performance assessments available to providers.

Have Questions? Email the National Quality Award team at
CMS Skilled Nursing Facilities/Long Term Care Open Door Forum


Date: Thursday, August 5, 2021
Time: 2:00 PM – 3:00 PM ET
Dial In Number: 1-888-455-1397
Passcode: 8604468


Opening Remarks
Announcements & Updates
Open Q&A
Nursing Home Media Toolkit

Check out the new Nursing Home Media Toolkit from the Maryland Department of Health. The password to access the materials is Vaccine2021.

Please use the materials in this media toolkit to spread the word about vaccination with staff.

You'll find flyers, ads, social media posts, videos, and posters. 
The 2021 HFAM Conference “Together We Re-Imagine” will be held in person October 4 – 7, 2021 at the Maryland Live Hotel and Casino in Hanover, Maryland. Hundreds of long-term care leaders will connect, share best practices and discuss actionable insights on how we can reflect, reform, rebuild, and revolutionize quality care. You and your teams will not want to miss this opportunity as we come together again.

Visit the conference website to learn more and register.
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